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ent000605-012
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I agree.iember Account-Number 3T3Tl03Sb2 01001; Cardmember Name 12/76 THRU 11/77 DONN ARDEN 69 Service- Establishment Date of Charge w206767*296673 TALK OF THE TOWN LONDON W.C.2. 942 ,1Q0 110 8 . :i Establish ' f L:mif to American Exp* Arhexco) Tips/Misc. or Authorized Representative for payment. Merchandise and/or sefvice purchased on this gard shall not be resold or returned for cash je*fund. J Cardmember Signature X >7?/77 TotW z-' '%/' T Any delayed charges are entered below: Type of Delayed Chg. Mm. of Delayed Chg. Revised Total Amexcbuse^Jniy^ Equivalent Amt. 357BM2V American Express Card Record of Charges Cardmember Copy